PURPOSE OF REVIEW: Conventional transurethral resection of bladder tumor (cTURBT) is the standard approach to the diagnosis and treatment of nonmuscle invasive bladder cancer. However, it suffers from inherent limitations such as insufficient assessment of resection depth and the need for intravesical tumor fragmentation that hampers histopathological evaluation. We summarize recent clinical data on en bloc resection of bladder tumor (ERBT), a method that promises to overcome these limitations. RECENT FINDINGS: The PubMed/Medline databases were searched for reports on ERBT focusing on trends in the last 2 years. ERBT provides greater resection quality, making up to 95% of detrusor muscle available for pathological evaluation. ERBT also allows detection of the muscularis mucosae thus facilitating T1 substaging. Available data demonstrate no significant difference in perioperative morbidity. No conclusions can be drawn on the impact of either modality on tumor recurrence and progression, as the available data is too underpowered. SUMMARY: ERBT is gaining acceptances as there is increasing evidence that it improves the quality of resected specimens. There seems to be no difference in perioperative morbidity between ERBT and cTURBT. The impact of ERBT on important endpoints such as recurrence and progression remains to be fully elucidated in further studies.

Department of Urology Medical University of Vienna Vienna Austria Department of Urology The Jikei University School of Medicine Tokyo Japan Institute for Urology and Reproductive Health 1 M Sechenov 1st Moscow State Medical University Moscow Russia Department of Urology Weill Cornell Medical College New York New York Department of Urology University of Texas Southwestern Dallas Texas USA Karl Landsteiner Institute of Urology and Andrology Vienna Austria Department of Urology 2nd Faculty of Medicine Charles University Prague Czech Republic

Zobrazit více v PubMed

Antoni S, Ferlay J, Soerjomataram I, et al. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol 2017; 71:96–108.

Babjuk M, Bohle A, Burger M, et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 2017; 71:447–461.

Xylinas E, Kent M, Kluth L, et al. Accuracy of the EORTC risk tables and of the CUETO scoring model to predict outcomes in nonmuscle-invasive urothelial carcinoma of the bladder. Br J Cancer 2013; 109:1460–1466.

Schraml J, Silva JDC, Babjuk M. Current concept of transurethral resection of bladder cancer: from re-transurethral resection of bladder cancer to en-bloc resection. Curr Opin Urol 2018; 28:591–597.

Shariat SF, Milowsky M, Droller MJ. Bladder cancer in the elderly. Urol Oncol 2009; 27:653–667.

Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. PLoS Med 2009; 6:e1000100.

Kawada T, Ebihara K, Suzuki T, et al. A new technique for transurethral resection of bladder tumors: rotational tumor resection using a new arched electrode. J Urol 1997; 157:2225–2226.

Kramer MW, Altieri V, Hurle R, et al. Current evidence of transurethral en-bloc resection of nonmuscle invasive bladder cancer. Eur Urol Focus 2017; 3:567–576.

Hayashida Y, Miyata Y, Matsuo T, et al. A pilot study to assess the safety and usefulness of combined transurethral endoscopic mucosal resection and en-bloc resection for nonmuscle invasive bladder cancer. BMC Urol 2019; 19:56.

Cheng B, Qiu X, Li H, Yang G. The safety and efficacy of front-firing green-light laser endoscopic en bloc photoselective vapo-enucleation of nonmuscle-invasive bladder cancer. Ther Clin Risk Manag 2017; 13:983–988.

Xu H, Ma J, Chen Z, et al. Safety and efficacy of en bloc transurethral resection with 1.9 micron vela laser for treatment of non-muscle-invasive bladder cancer. Urology 2018; 113:246–250.

Zhang KY, Xing JC, Li W, et al. A novel transurethral resection technique for superficial bladder tumor: retrograde en bloc resection. World J Surg Oncol 2017; 15:125.

Balan GX, Geavlete PA, Georgescu DA, et al. Bipolar en bloc tumor resection versus standard monopolar TURBT – which is the best way to go in noninvasive bladder cancer? Rom J Morphol Embryol 2018; 59:773–780.

Cheng YY, Sun Y, Li J, et al. Transurethral endoscopic submucosal en bloc dissection for nonmuscle invasive bladder cancer: a comparison study of HybridKnife-assisted versus conventional dissection technique. J Cancer Res Ther 2018; 14:1606–1612.

Li K, Xu Y, Tan M, et al. A retrospective comparison of thulium laser en bloc resection of bladder tumor and plasmakinetic transurethral resection of bladder tumor in primary nonmuscle invasive bladder cancer. Lasers Med Sci 2019; 34:85–92.

Onishi T, Sugino Y, Shibahara T, et al. Randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of nonmuscle-invasive bladder cancer. BJU Int 2017; 119:276–282.

Abotaleb AA, Kandeel WS, Elmohamady B, et al. Bipolar plasma kinetic enucleation of nonmuscle-invasive bladder cancer: Initial experience with a novel technique. Arab J Urol 2017; 15:355–359.

Zhang J, Wang L, Mao S, et al. Transurethral en bloc resection with bipolar button electrode for nonmuscle invasive bladder cancer. Int Urol Nephrol 2018; 50:619–623.

Impact of sex on outcomes after surgery for non-muscle-invasive and muscle-invasive bladder urothelial carcinoma: a systematic review and meta-analysis